Book review 'The Empire of Trauma: An Inquiry into the Condition of Victimhood by Didier Fassin & Richard Rechtman

Fassin and Rechtman’s aims are not to explore individual experiences of victimhood or trauma. Instead their concern is with the social and political impact of the concept of ‘trauma’ as an increasingly used resource for making sense of a wide range of suffering. Addressing a multi-disciplinary audience, and initially taking a historical perspective, they explore ‘how we have moved from a realm in which the symptoms of the wounded solder or the injured worker were deemed of doubtful legitimacy to one in which their suffering, no longer contested, testifies to an experience that excites sympathy and merits compensation

Shame as a social phenomenon: A critical analysis of the concept of dispositional shame

An increased clinical interest in shame has been reflected in the growing number of research studies in this area. However, clinically-orientated empirical investigation has mostly been restricted to the investigation of individual differences in dispositional shame. This paper reviews recent work on dispositional shame but then argues that the primacy of this construct has been problematic in a number of ways. Most importantly, the notion of shame as a context-free intrapsychic variable has distracted clinical researchers from investigating the management and repair of experiences of shame and shameful identities, and has made the social constitution of shame less visible. Several suggestions are made for alternative ways in which susceptibility to shame could be conceptualised, which consider how shame might arise in certain contexts and as a product of particular social encounters. For example, persistent difficulties with shame may relate to the salience of stigmatising discourses within a particular social context, the roles or subject positions available to an individual, the establishment of a repertoire of context-relevant shame avoidance strategies and the personal meaning of shamefulness

The concept of shame and how understanding this might enhance support for breastfeeding mothers

The purpose of this paper is to explore the usefulness of the concept of shame and the literature on shame management for understanding the experiences of women who struggle to establish breastfeeding. In particular we consider what this literature might suggest with regard to good practice when supporting breastfeeding mothers, illustrating our discussion with data from two previous empirical studies. There is increasing evidence from qualitative explorations of women’s experiences of breastfeeding that, for some mothers, breastfeeding can be a psychologically uncomfortable or even distressing experience. This seems particularly likely where there are difficulties establishing successful feeding which are counter to a mother’s previous expectations and where she may then feel she is positioned by discourses of ‘good’ or ‘natural’ mothering as failing both as a mother and a woman (e.g. Williamson et al., 2012). Previous discussions of the potential for breastfeeding promotion to cause distress for women who do not breastfeed or who struggle to do so have tended to assume that the problem is guilt. In response to this a frequently made point has been the importance of recognising that apparent ‘failures’ to breastfeed are not best understood as the mother’s omission or ‘choice’ but instead as a consequence of the many barriers to breastfeeding in Western societies. Thus the possibility is created for breastfeeding advocacy to target the many ways in which breastfeeding is made difficult for women, rather than blaming mothers. However, as Taylor and Wallace (2012) point out, women’s emotional responses may be more complex than has sometimes been assumed and for many mothers who struggle with breastfeeding or turn to formula milk, shame may be as much if not more of an issue than guilt. As such the identity work which mothers engage in to make sense of not breastfeeding (e.g. Marshall, Godfrey & Renfrew, 2007) can perhaps be viewed as a form of shame avoidance. There have been several attempts to distinguish shame from guilt, and we draw on Gilbert’s (2003) work as one of the most comprehensive models which usefully highlights the differing experience of relations with others when we feel guilty or ashamed. Guilt suggests a relatively powerful position where we are able to hurt another by our actions or omissions and we may then be motivated to make reparation. However, shame can be a much more destructive emotion and therefore difficult to manage. When we are ashamed we experience ourselves as inferior or flawed before a more powerful critical ‘other’, whether this is an actual person we perceive as devaluing us or a sense of a generalised ‘other’ in front of whom we are inadequate and lesser. With shame the focus is on a sense of a damaged and unable self, rather than on specific actions. Therefore an example of shame would be a mother whose distress about feeding difficulties arises from the possibility to her that these difficulties mean she is fundamentally flawed or inadequate as a mother, and possibly exposed as such before critical others. This is a rather different emotional experience from a sense of guilt towards her baby for providing less than optimal nutrition, though the two are not mutually exclusive. We discuss some of the ways in which shame and the avoidance of shame may challenge a mother’s relationships with others, including her developing attachment with the baby and her interactions with breastfeeding supporters. Drawing on literature on shame management and some of our own research data, we suggest a number of ways in which healthcare practitioners may be able to help women to manage or repair feelings of shame. For example, Brown’s (2006) research on women’s experiences of shame in a range of contexts suggests that establishing relationships with breastfeeding women which validate both their experiences and emerging identities as mothers is important for providing a space in which it is safe to acknowledge, examine and contextualise often unspoken and taboo feelings of shame. In this way, the research on shame management supports recent proposals for breastfeeding support to adopt a more person-centred focus (e.g. Hall Moran et al., 2006). Finally, in reviewing the usefulness of a focus on shame, we reflect briefly on the irony that the most visible examples of breastfeeding in public may paradoxically be viewed as shameful acts. This underscores the difficulties that women may face within contemporary Western societies in resisting shame in relation to breastfeeding

Mothers of lower socio-economic status make the decision to formula-feed in the context of culturally shared expectations and practices. Invited commentary on: Carroll M, Gallagher L, Clarke M, et al. Artificial milk-feeding women’s views of their feeding choice in Ireland. Midwifery 2015; 31:640–6.

• Within some communities women may already view formula-feeding as the obvious infant-feeding choice, even before pregnancy. Therefore, breastfeeding promotion should not be focused just on pregnant women, but on the wider community. • Exposure to other women breastfeeding may help to promote breastfeeding during pregnancy. • Research methods which enable more sustained engagement with participants may facilitate further understanding of the perspectives of mothers from communities where formula-feeding is dominant

Changing the Conversation: Shelving Shame

In this article I consider how women’s experiences of breastfeeding difficulties interrelate with the concept of ‘shame’. Difficulties establishing breastfeeding are frequently interpreted by mothers as a sign that they have failed or are inadequate as a mother,24,25,26 an emotional experience which has often been described as ‘shame’ rather than ‘guilt’, though the two are closely related and are often experienced together. I suggest that overcoming shame will be a necessary condition for better conversations

Managing the dynamics of shame in breastfeeding support

Breastfeeding promotion has long grappled with the issue of maternal guilt. However, recently attention has turned instead to shame, as a related but more problematic emotional response. Although women may talk about feeling shamed for breastfeeding in front of others, some also talk about shame-related feelings as a consequence of not breastfeeding or struggling to establish breastfeeding. Research suggests that cultural representations of breastfeeding can be taken up as if they imply that the ‘good mother’ not only breastfeeds but also has a maternal body which sustains her child with ease. Therefore, where breastfeeding difficulties are experienced, these can be taken by women to signify inadequacy or failure as a mother and woman, particularly if there is a sense of exposure before expert surveillance. The purpose of this presentation is to explore the usefulness of interpersonal theories of shame, shame avoidance and shame management for understanding relationships between women who struggle to establish breastfeeding and those who support them. Drawing on Gilbert’s (2003) and Scheff’s (1995) approaches to shame, which emphasise the sense of a devalued position in relation to others, I consider how shame and shame avoidance might sometimes shape the dynamics of relationships between breastfeeding women and healthcare providers in ways that are counterproductive for both breastfeeding and the wellbeing of breastfeeding women. However, I also explore what the emerging literature on shame management and resilience (e.g. Brown, 2006; Leeming & Boyle, 2013; van Vliet, 2008) might have to offer with regard to countering shame when supporting breastfeeding mothers by promoting meaningful connection, validation of women and contextualisation of breastfeeding difficulties

Evaluating the audio-diary method in qualitative research

Purpose Audio-diary methods are under-utilised in contemporary qualitative research. In this paper we discuss participants and researchers’ experiences of using audio-diaries alongside semi-structured interviews to explore breastfeeding experiences in a short-term longitudinal study with 22 first-time mothers. Design/methodology/approach We provide a qualitative content analysis of the participants’ feedback about their experiences of the audio-diary method and supplement this with the perspectives of the research team based on fieldwork notes, memos and team discussions. We pay particular attention to the ways in which the data attained from diaries compared with those from the interviews. Findings The diaries produced were heterogeneous in terms of data length and quality. Participants’ experiences with the method were varied. Some found the process therapeutic and useful for reflecting upon the development of breastfeeding skills whilst negative aspects related to lack of mobility, self-consciousness and concerns about confidentiality. Researchers were positive about the audio-diary method but raised certain ethical, epistemological and methodological concerns. These include debates around the use of prompts, appropriate support for participants and the potential of the method to influence the behaviour under scrutiny. Interview and diary accounts contrasted and complemented in ways which typically enriched data analysis. Practical implications The authors conclude that audio-diaries are a flexible and useful tool for qualitative research especially within critical realist and phenomenological paradigms Originality/value This appears to be the first paper to evaluate both participants and researchers’ experiences of using audio-diaries in a detailed and systematic fashio

Shame as a social phenomenon

Purpose: This paper argues for a theoretical approach to chronic shame which emphasises social factors in the development of psychological problems. Some of the implications of this for research and clinical practice are considered. Context: Clinical psychologists are increasingly drawing on the concept of shame to inform therapeutic work. However, a comprehensive review of clinically-orientated research on shame over a four-year period revealed that this has mostly been restricted to the investigation of individual differences, conceptualising shame as an attribute of the individual. Key Points: It is argued that the notion of shame as a context-free intrapsychic variable has distracted clinical researchers from investigating shame as a lived emotional experience and has made the social constitution of shame less visible. As such, there is very little data available on the avoidance, management and repair of experiences of shame and little exploration of how shameful identities might emerge in particular social contexts. Several suggestions are made for alternative ways in which susceptibility to shame could be conceptualised, which consider the individual’s social world and the importance of the roles or subject positions available. Conclusions: To better inform clinical practice, research needs to focus more explicitly on the social and interpersonal processes which either enable or inhibit the avoidance, management and repair of shame. The implications of a more contextualised understanding of shame for practitioners include a willingness to (a) work with clients at achieving real changes in their social worlds and (b) to develop services which offer positive identities for user

Young people’s images of cigarettes, alcohol and drugs.

To meet their aim of reducing the acceptability of psychoactive substances to young people, the designers of drug prevention programmes need to have a thorough understanding of the personal views already held by their audience with respect to the object of attitude and behavioural change. However, few studies involving younger adolescents have collated participant-generated impressions of a range of legal and illegal substances. The present study used a word association methodology to explore adolescents' impressions of cigarette smoking, drinking alcohol and taking a range of illegal drugs. In total, 3571 images were generated which were placed into 24 categories on the basis of content analysis. The predominance of negative imagery was of note, particularly for cigarette smoking and drug taking and there was little evidence of a simplistic generic attitude to substance use. Images of alcohol, especially alcopops, were markedly more positive and were much less likely to contain reference to specific health problems than the images of cigarette smoking. However, there was less differentiation between 'hard' and 'soft' illegal drugs than has been found with older adolescents in other studies and many of the images relating to illegal drugs were poorly defined, revealing vague notions of danger and risk. The present methodology is proposed as a useful tool for assessing attitudes both prior to and following prevention programmes and it is suggested, based on the wide variation in images elicited, that successful prevention dialogues with young people may need to vary their message according to the particular substance targeted

Understanding process and context in breastfeeding support interventions: The potential of qualitative research

Considerable effort has been made in recent years to gain a better understanding of the effectiveness of different interventions for supporting breastfeeding. However, research has tended to focus primarily on measuring outcomes and has paid comparatively little attention to the relational, organisational and wider contextual processes that may impact delivery of an intervention. Supporting a woman with breastfeeding is an interpersonal encounter that may play out differently in different contexts, despite the apparently consistent aims and structure of an intervention. We consider the limitations of randomised controlled trials for building understanding of the ways in which different components of an intervention may impact breastfeeding women and how the messages conveyed through interactions with breastfeeding supporters might be received. We argue that qualitative methods are ideally suited to understanding psychosocial processes within breastfeeding interventions and have been under-used. After briefly reviewing qualitative research to date into experiences of receiving and delivering breastfeeding support, we discuss the potential of theoretically-informed qualitative methodologies to provide fuller understanding of intervention processes by focusing on three examples: phenomenology, ethnography and discourse analysis. The paper concludes by noting some of the epistemological differences between qualitative methodologies and the broadly positivist approach of trials, and we suggest there is a need for 1 Understanding Process in Breastfeeding Support 2 further dialogue as to how researchers might bridge these differences in order to develop a fuller and more holistic understanding of how best to support breastfeeding women